While urbanisation has brought improvements in areas such as housing, education, employment, social support, and healthcare, the rapid pace of these changes is drastic from an evolutionary standpoint (Song et al., 2018). Recent studies suggest that city dwellers face consistent stressors, and urban living is associated with a higher risk of mental health issues (Lederbogen et al., 2011). Peen et al. (2010) have reported that urban residents face a 39% higher risk of mood disorders and a 21% higher risk of anxiety disorders. More recently, Kasap et al. (2021) have found that disconnection from nature directly contributes to depression, anxiety, and a loss of meaning in life. Orr (1993) suggests that connecting to nature is the necessary path toward wholeness, and many therapists are starting to broaden the scope of traditional therapy to include nature. Incorporating ecotherapy into psychotherapy practices brings some challenges, but also creates opportunities that can mutually benefit therapists and their clients. This essay will explore the basics of ecotherapy, discuss how ecotherapy can be incorporated into psychotherapeutic practice, review relevant vignettes, and provide a critical analysis.
Background
Ecotherapy is a relatively new modality that continues to grow and diversify in its approaches and areas of specialisation (Brazier, 2022). Clinebell (1996) introduced the term ecotherapy, which refers to a therapeutic approach that aims to bring individuals into a deeper relationship with their natural environment (Wolsko & Hoyt, 2012). While psychotherapy encourages us to explore the stories of our human relationships, ecotherapy expands the traditional scope of treatment to encompass the relationship between humans and nature (Rust, 2020). While ecology examines the relationships between organisms and their environment, ecotherapy teaches us that just as ecological connections exist in nature, they also apply to our lives (Meacham, 2020). Because ecotherapy operates under the belief that everything is interconnected, reality is seen as inherently relational and shaped by the fluid boundaries and interactions between different forms of life. Therefore, as we embrace the reality of our interconnectedness, the source of personal and collective meaning begins to shift (Meacham, 2020).
Ecotherapy often serves as an umbrella term for many therapeutic practices incorporating nature, such as ecopsychology, ecopsychotherapy, nature-based therapy, and mindfulness-based therapy (Key & Tudor, 2023). Within the various forms of eco-therapeutic practices are specialisations, such as adventure therapy, animal-assisted therapy, garden and horticultural therapy, forest therapy, wilderness therapy, and adventure therapy (Harper & Dobud, 2021). Given the wide variation in which ecotherapy is utilised, this essay focuses on exploring and examining the lineage of ecotherapy that relates to a psychotherapeutic approach. The core concept is that our mental, emotional, and spiritual well-being depends on healthy relationships within our families and communities and a strong connection with the natural world (Meacham, 2020).
Hypothesis and Theories
One hypothesis and two theories support the fundamental concepts of ecotherapy. Kellert and Wilson (1993) developed the biophilia hypothesis, which suggests that as society grows increasingly disconnected from nature, there could be significant negative impacts on our well-being. The essence of the biophilia hypothesis speaks to humanity’s innate affiliation with nature, regardless of cultural background, and our connection to nature is so prevalent that it influences the human mind cognitively and behaviourally (Selhub & Logan, 2012).
Kaplan and Kaplan (1989) developed Attention Restoration Theory (ART), which proposes that spending time in nature assists with overcoming mental fatigue while improving focus and concentration. According to Ackerman (2018), multiple studies have tested ART and reported reliable evidence that restorative natural environments can alleviate symptoms of mental fatigue, stress, and ADHD. However, a literature review conducted by Ohly et al. (2016) reported that the meta-analysis for 21 studies showed significant positive effects from exposure to nature, while the meta-analysis for ten additional studies showed no significant positive effects. They recommend that ART researchers clearly define which attention measures best capture the effects of restoration and then apply these measures consistently across various studies to minimise the diversity of evidence reported (Ohly et al., 2016).
Ulrich (2023) developed the Stress Recovery Theory (SRT), which suggests that the stress-reducing effects of nature are universally experienced across various cultures and geographic locations. It also proposes that recovery from stress occurs more quickly and thoroughly when individuals are exposed to natural settings compared to industrial or urban environments, resulting in a general emotional shift toward more positive feelings. A theoretical analysis performed by Jones and Littzen (2022) reported that fallacies have not been found with SRT; it has received empirical support in the literature for decades due to its consistent predictability across various fields of research.
Taking Psychotherapy Outdoors
The most common and readily available way to incorporate ecotherapy into an office-based psychotherapy practice is walking or sitting alongside the client outside in nature (McKinney, 2012). In traditional psychotherapy, the ‘analytic third’ is described by Ogden (2004) as the psychological space between the therapist and client where reparation and integration occur. In ecotherapy, nature becomes the third space, which either serves as a backdrop or takes centre stage in the process, offering powerful metaphors and symbols that enhance the work (Jordan, 2022). Additionally, being outdoors can evoke somatic insights that are often harder to access in the more static setting of a therapy room (Marshal, 2022). It also awakens extrasensory perception and revitalises senses that are often dormant or atrophied (Meacham, 2020). According to Gendlin (1978), clients with a strong felt sense progress quicker during therapy than those who do not. Furthermore, the physical aspect of being held by nature enhances the therapist’s ability to be more aware, grounded, and focused, making it easier for the client to stay relaxed through bodily resonance with their therapist (Brazier, 2022). Considering that many studies show evidence that exposure to nature increases psychological well-being and decreases stress, depression, and anxiety (Bratman et al., 2019), helping clients strengthen their connection to nature can be beneficial (Chang et al., 2024).
Bringing Ecotherapy Indoors
For many psychotherapists, taking their practice outdoors may not be a convenient option. Fortunately, adding natural elements to a therapy room can provide effects similar to being outdoors. Mizumoto et al. (2024) found that looking at natural images for three minutes decreased depression and enhanced mood. Delaney (2020) recommends adding green plants, using essential oils, providing natural light and playing nature-based background music. Appendix E is an example of how a therapist utilised a collection of natural items combined with a metaphor to “frame the client’s issues within a wider and deeper context, thus gaining a different perspective” (Hasbach, 2002, p. 143).
Vignettes
The following collection of vignettes provides a variety of examples that demonstrate how incorporating ecotherapy into a psychotherapeutic practice can benefit both the therapist and the client. The first vignette (see Appendix A) is about a female working through feelings of unworthiness stemming from the rejection she experienced from overpowering family members. The therapist found outdoor therapy valuable because it gave her a deeper understanding of the client’s perceived physical reality. Nature offers clients a space to regulate their emotions and serves as a regulatory space to assist therapists in processing challenging emotional material, especially when dealing with projective identification (Jordan, 2022). In this example, the therapist could identify the somatic countertransference that was present because of the role that walking in nature played. She was able to guide her client through the somatic distress, which directly correlated to the distress the client felt as a child. Additionally, the therapist and the client could “regulate their emotional responses to each other and feel held by nature as embodying and representing a transitional space” (Jordan, 2022, p. 67). Through the somatic encounter with the natural environment, the client could reinterpret her experience within a broader context (Kaplan & Talbot, 1983).
The second vignette (see Appendix B) is about a male struggling at work and in his marriage. The therapist took the sessions outdoors because the client was reluctant to speak and appeared uncomfortable. Jordan (2022) states that being in nature gives the therapist and the client more ways to relate to each other and that being outdoors is less threatening to the client because of less direct eye contact. In this example, the therapist utilised bird observation during their outdoor sessions, which helped the flow of their conversations, reconnected the client to nature, and provided a safe container to reevaluate his approach toward work and his marriage. Kaplan and Kaplan (1989) referred to this phenomenon as soft fascination, suggesting that contemplating the natural world creates ideal conditions for the brain’s attentional recovery, particularly in the frontal cortex, which helps clear the mind and foster the development of new patterns of perception (Brazier, 2022; Marshal, 2022).
The third vignette (see Appendix C) is about a young girl who was crippled with anxiety, resulting in conflict between herself and her mother. Burns (2009) proposes that the most significant sources of happiness, enjoyment, and pleasure are found in nature. He states, “For families caught in a cycle of conflict, it often comes as a relief that their initial therapeutic contact does not become embroiled in unresolved issues but directs them toward individual and mutual experiences they enjoy.” (Burns, 2009, p. 99). Providing a playful setting outdoors allowed the client and her mother to connect deeply to each other and nature. The use of metaphors has been a long-standing tradition in psychotherapy, and it has naturally carried over into ecotherapy (Harper & Dobud, 2021) because flora and fauna are so rich in context. The therapist used the client’s observations of nature to create metaphors that helped teach the client ways to understand and co-regulate her anxiety. Using metaphors also helped to build her confidence, create more self-awareness, and learn how to name her feelings. In this example, nature acted “as another presence which both guides and provokes therapeutic process” (Jordan, 2022, p. 67).
The fourth vignette (see Appendix D) concerns a group ecotherapy session in an in-patient addiction clinic. This story is a powerful example of how the natural environment provided a safe container that cultivated the expression of care for each other and made use of nature as a transitional object to help them release guilt, which served as a bridge for them to establish a meaningful connection to the natural world. As stated by Andrews (2009), “Simple as it is, the small group can help us learn to cooperate rather than compete. Caring begins with ourselves and other people, but it enlarges us in a way that leads us to care for the rest of nature as well. When we begin to care, we want to protect all of life (p. 193)”.
The therapist utilised a technique called projective work, as described by Brazier (2018). Externalising their feelings of grief through the use of the stones allowed for discussion, exploration, and transformation in a more structured and contained manner than through conversation alone. The outdoor environment became a neutral witness to each client’s story, and nature became a partner in the therapeutic relationship, one of the many unique features that Hasbach (2002) attributes to taking therapy outside so beneficial.
Critique
Ecotherapy has received much criticism for various reasons. Wolsko and Hoyt (2012) identified five obstacles: lack of time and money, confidentiality issues, difficulty with location, some clients considering it irrelevant, and some therapists finding it hard to implement. Hasbach (2013) speaks to the added precautions needed to avoid safety hazards, the added time it takes to document preparatory discussions with the client, and the added responsibility to nurture nature reciprocally. Brazier (2018) suggests that being outdoors feels less formal than being in an office, so personal boundaries can be more challenging for the therapist to maintain. Additionally, Chang et al. (2024) recently found that a person’s connection to nature influences how their mental health responds to the amount of time spent in natural environments. This finding leads to two important considerations. First, outdoor therapy may only benefit some clients, and proper assessment is needed to determine the most suitable setting. Second, all other research cited in this essay did not consider the participant’s connection to nature as a contributing factor to the results generated, which may explain the recurrence of mixed findings. In future research, adding the metric of connection to nature will likely result in more accurate and consistent data.
Conclusion
Incorporating ecotherapy into a psychotherapeutic practice has some challenges because it is still relatively new. However, it also comes with many benefits. It benefits the therapist because nature can serve as a therapeutic partner, provide added context and metaphors to help guide the client, heighten the senses, and provide physical support through grounding and holding. It benefits the client because exposure to nature can help regulate emotions, reduce stress, create new patterns of perception, and improve mental health and well-being. While studies show mixed results on ecotherapy’s effectiveness, researchers are finding new ways of testing more accurately. Therefore, further advancements in this field are promising.
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Appendix A
Vignette #1 – Embodied Relational Depth
I think that in outdoor therapy, therapists have golden opportunities to explore a somatic immersion in the dynamic experience of their clients, consequently finding out more about the lived physical reality of their past and present worlds.
Fiona – ‘the runt of the litter’
Throughout our work to this point, we had explored Fiona’s relationship with her own body, which she felt to be letting her down much of the time. In a winter session several months into our work, Fiona and I are walking a narrow path up the hill; she is talking about events in her week. However, what is standing out for me is a sense of her straining her body to keep up, even though we are moving slowly. I begin to feel tightness in my stomach, as she seems to be trying to shove her body forward alongside me. I am suddenly aware that I feel very physically capable and powerful. I muse on the significance of all this happening in my body as she continues to talk, and I notice that I am also beginning to feel some level of irritation with her and, interestingly, an urge to push her!
I reflect aloud about some of my experience with her. There is a moment of silence in which she appears to flush, and I wonder if this has been too much, too soon. However, she seems to take my lead and also begins to recount her experience of her body, especially in relation to mine. She says that she experiences mine as a strong, competent body capable of walking with ease up the hill, and hers as a useless body that lets her down at every juncture. She says, ‘I’m letting you down, because I can’t even walk up this hill properly.’
We stop, as she begins to feel ‘shaky and nervous’ about sharing these feelings with me. We stand together as I invite her to stay with what’s happening, and then she cries, she feels ‘useless’. In this moment, she connects to being what she eventually describes as ‘the runt of the litter’ in her large family and to her physical sensations of being violently rejected: ‘It’s like I’m no good…and the others are always after me,’ she says.
For Fiona, this is a fuller expression of her protocol level. Though her manner of moving her body (the straining and shoving) as a way of keeping up with me, I seemed to sense something powerful from her. Pursuing this path led to her connecting with her early way of being in the world in relation to other more domineering members of her family.
As described in the previous examples, Fiona’s protocol was present in embryonic form in the early sessions (as we first walked up the track) and gradually became more and more embodied through the therapy. At this point in the work, her sense of worthlessness, physical weakness and vulnerability in relation to others is captured with greater physical intensity in the course of our walk up the hill. In terms of my somatic countertransference, I think both my feeling a level of aggression towards Fiona within my body and my external reflection upon this were significant in her accessing her protocol experience. I think that this demonstrates the potential increased capacity of the therapist to ‘know’ the client through moving around in this type of therapeutic setting. As we walked up the hill, I really got a strong sense of how Fiona functioned with others in the world, influenced by her protocol. So the therapist can use his or her own moving and enlivened body to help make sense of what’s happening for the client on a protocol level. This involves working in what is effectively an intensification of the somatic transference between therapist and client (Marshal, 2002, pp. 155-156).
Appendix B
Vignette #2 – Reclaiming Relationships and Reconnecting to the Natural World
Joseph and I spent some sessions getting to know each other. He was reluctant to talk too much and seemed uncomfortable in his skin. My indoor office is small, on a busy street, and, for privacy, the blinds are kept mostly closed. We met on the couch at first because the weather was cold and rainy those first few weeks. I was worried, after the first few meetings, that he would not return. After the third session, I spoke to Joseph about meeting in a local park to walk and talk rather than meet inside. He agreed, and, going forward, we met at the park.
The transformation for me was obvious, even though I did not know Joseph that well yet. His face softened; he looked more alert and alive. He walked with a brisk pace but would stop and notice things, especially birds. We would be walking and then he would stop and get quiet. He would listen to the bird songs, wondering how he could figure out what species was making that call. We really started to work. While we walked, Joseph told me about his job, his work climate, and his coworkers. He struggled with getting older at work and watching the younger employees come in and take over projects and responsibilities. He thought that they were different than he was at their age. He said they did not respect the older generation, were impulsive, and thought they “knew it all.” He felt as if, despite his years of experience and his considerable working knowledge, he was becoming invisible.
We talked about how he felt when he was at work. It was not surprising to me that he felt suffocated and, despite being surrounded by others, very isolated and alone. The windows were in the perimeter offices, and so there was barely any natural light. The office lacked any color or natural elements and was basically a sea of people, computers, files, and papers. While he used to like his work, Joseph now felt like he could not keep up. Deadlines were tight, and the pressure was always on to work fast and under budget. He told me how he used to love certain aspects of his job. He was able to be creative, think critically, make decisions, and be in control. When a project was completed, he felt satisfied. He told me he did not have any of those emotional reactions anymore.
He knew his relationship with his wife was suffering, yet he did not know where to begin. So we began with the birds. I brought a local bird book for our area to one of our meetings. I know a few bird songs, so we began with the robins, sparrows, and cardinals. We brought a journal and wrote down what birds we saw on our walks. Over the next several weeks, Joseph walked, talked, and sometimes silently listened for birds and recorded in his journal what we saw that day. In between sightings, we talked about Joseph’s childhood, his expectations for his future, and his depressed mood and lack of energy (Delaney, 2020, pp. 50-52).
Joseph and I worked together for several months in order to understand and reflect on his own story. Over that time, he became quite the bird lover and joined a local Audubon association, where he made new friends and connections. The greatest lesson of our time together, he told me, was that his work identity did not have to define him. He still had to work, for now, to support his family, but he was more relaxed at work and less reactive to stressors he could not control. He took mini-breaks during the day to get a touch of nature and to reenergize. He added elements of nature to his home and his work space: pictures of his family doing a fun activity outdoors, plants on his desk, and a small lamp that emits a gentle glow. Even his coworkers commented on how they felt less stress just being in his space at the office. Overall, he was more relaxed and, as a byproduct, more productive at work. He had more energy for himself, his spouse, and his children. Of course, not all of his issues were resolved; he was still in a job he didn’t love. But he felt rejuvenated and more capable of tackling new issues as they arose. He also shifted his focus, rebalancing his understanding of what was important to him, including things he could control and things he could not. We agreed that some of his newfound understanding was the result of the therapeutic process, but Joseph reflected that his reconnection with nature was a catalyst for change (Delaney, 2020, p. 64).
Appendix C
Vignette #3 – Nature as a Partner in the Therapeutic Relationship
A common occurrence is for families to seek out nature-based counselling following several trials with office-based modalities. They hope an alternate approach may meet the unique needs and disposition of their child. In one instance, Miriam, a ten-year-old struggling with debilitating worry, stomach aches, trouble falling asleep, and feelings of overwhelm and panic occurring at school, agreed to try a nature-based approach. Miriam’s anxiety had resulted in increased conflict with her mother, such as getting to school in the morning or going to sleep at night, which understandably had taken its toll on their relationship and exacerbated her symptoms.
The sessions began with nature-based play and exploring the local forested park. The mother was encouraged to follow her daughters’ lead, bringing forth curiosity and her own child-like self. Sessions would start with an experiential check-in involving moving between two trees and placing themselves where they believed they were at in response to questions such as, how are you doing in this particular moment, the past week, at school/work and other relevant areas. The therapist encouraged naming current feelings, without judgment and deepening these accounts. They were also invited to say what they were grateful for in the forest that day (awakening enthusiasm). Additionally, the concept of sensory awareness was emphasized, and a short-guided mindfulness exercises would prompt them to notice different colors and shades of greenery, listen to the forest sounds, and feel the various textures such as the wind on their face, warmth of the sun, or softness of the moss. These exercises would assist in shifting their focus from the busyness of their day and into the present moment (directed attention).
These initial sessions, although they did not explicitly address the presenting concerns just yet, had a number of important aspects. First, it allowed for a strong therapeutic alliance to be established between the family and the counsellor, as well as between the family and nature (bonding and belonging). Further, Miriam and her mother experienced opportunities for reparative connection which was a relief from the constant strain and opposition that was occurring at home, serving to fill up their connectivity bank. On one of those early meetings the weather was quite rainy and despite the wetness, Miriam was engaged in her explorations of a determined slug making its way across the trail. This experience allowed for a number of metaphors to arise. First the ways in which emotions are like the weather. How they shift and change, how we do not have control over them, but how we can adjust how we relate to them (nature as mentor). Also, the determination of the slug was likened to the same tenacity Miriam was showing in her relationship with anxiety and how she continuously works hard to figure out ways to stay at school and tolerate the uncomfortable sensations and negative thoughts (Nature as mirror).
The rationale was to first work on regulation and the development of awareness skills. After which, parts of sessions were spent specifically exploring how anxiety is showing up in their lives and how they are managing. Also, they learned from the local animals, such as watching the way ground birds reacted to people walking by, and noticing how the birds’ nervous systems were responding effectively to keep them safe. These experiences allowed for discussions about Miriam’s nervous system and how she too has an alarm system, which has been alerting her to danger at school and at night. It was possible to use the analogy of the birds to explain how if they stayed in their nest and never took risks, they would not be able to get food and survive. Over time, she was developing the skills to face the uncomfortable feelings associated with anxiety, learning how to name her feelings and sensations, as well as developing the confidence to take action in the presence of fear. She was motivated to challenge herself and she understood that avoidance would continue to contribute to anxiety having control over her life. Miriam’s mom was developing both a conceptual and felt experience of nature connection practices as well as learning ways she can support Miriam with co-regulation, and awareness skills, and attuning to her needs. In this context, the nature-based approach allowed for visceral, lived experiences of regulation and modeling that may not have been as readily available for Miriam and her mother within an office setting. It also provided opportunities for enhanced connection and gratitude between mother and daughter. (Segal et al., 2021, pp. 102-104).
Appendix D
Vignette #4 – Projective Work with Stones
When I first started the group, I felt like I was all by myself trying to establish group norms and boundaries. I remember during one session a new client was giving me a hard time; he was cursing at me, refusing to participate, and trying to get the other clients riled up. Before I could even respond to him, another client said, “That’s not how we talk to Bethany and that’s not how we do group here. If you don’t want to come you can just stay inside.” The other group members supported this sentiment, and I realized we had truly started something special, something the clients wanted to protect. As I became more comfortable with the group, we were able to start trying new things.
Many of the clients came to treatment feeling angry, ashamed, guilty, and completely stigmatized by society. I wanted to address these feelings, so I decided to make use of the many rocks and stones around us. I asked the clients to gather rocks, one for each of the difficult feelings they were experiencing. They were to get a rock that physically represented the emotions they were carrying around. Clients were pretty resistant to this idea at first, and I was nervous they would use the rocks inappropriately. Many of the clients voiced their feelings about this activity by saying that it was stupid, it wasn’t going to help, and that rocks couldn’t possibly represent how they felt, but they did it anyway.
After they had all collected their rocks, we talked about what feelings they were representing. Clients were given the space to process some of the reasons they picked up a rock and quickly found they shared a lot of the same feelings. It was clear that an activity clients were unsure of at first had started to take them to a deep place where they could process difficult feelings. A common theme was guilt. Every single client in group that day spoke about the guilt they felt from the destruction and heartache that their addictions had caused. They had lost their homes, their children, their parents, their loved ones; they had damaged their own health and happiness; they let down their gods and spirits—they all had a story about the guilt that was ravaging them.
While we were processing, I asked them to hold the rock they had picked to represent this guilt and imagine they were putting all of that guilt into the rock as they spoke. One client said the rock got heavier and heavier as it took on this burden for him. At the end of our session, I asked the clients to let go of this guilt—to acknowledge it, to feel it, and to let it go. They looked at me like I was completely psychotic. I was met with cries of “We can’t just let it go!” and “It’s not that simple!” or “But I’ll always feel this way.” I asked them to try. At this point, we had built up enough trust and they agreed to try. They threw those rocks as hard and far as they could into the lake. A few clients let out a yell as they watched the rocks sink below the water. A few clients cried as they started to let go of what had been holding them down. I don’t know that anyone’s guilt was completely absolved that day, but something had opened up in them. There was a complete shift in the air, and I was a part of something more powerful than I can put into words. Many months had passed since that day, and I was getting ready to move across the country and leave my job behind when a former client came in to see me. It is such an honor to have a client come back because so often I can never know how a client’s journey progressed after he or she leaves treatment. It was the client who had given me a hard time. This was a client who nearly got kicked out of treatment for bad behavior and, frankly, one for whom much of the staff had little hope of truly recovering. He had come to thank me for my group and to apologize for his behavior. He was employed, living in a sober community, and was right in front of me asking for forgiveness for the things he had said. He told me that going outside for that group was the highlight of his day and that I helped him more than I could know. I know that this was not the work of just me; we were both part of something bigger than us—we experienced a deep and meaningful connection not only to other people but to the natural world (Delaney, 2020, pp. 96-97).
Appendix E
Vignette #5 – Metaphors
I keep a box of found nature objects in my office. It includes shells, rocks, seeds, sticks, bones, mosses, leaves and feathers. Sometimes, when clients seem to be stuck or at a loss for words, I’ll invite them to select an item they are drawn to from the box. One young woman, who was seeing me for depression ad issues related to a recent break-up with her boyfriend, was having difficulty articulating her feelings. When given the opportunity to select an item from the nature box, she chose a vine that had formed a hollow ball. She said it represented the emptiness she felt inside and the tangles she felt in the life. The vine ball provided a useful prop for her to describe her feelings (Hasbach, 2002, p. 140).
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